Complaint form

Complaint form

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Addressee:
[seller’s identification details]

COMPLAINT FORM

CUSTOMER DATA:

First name and last name: ………………………………………………………………..

Address: …………………………………………………………………………………………….

E-mail: ………………………………………………………………………………………………

Tel .: ………………………………………………………………………………………………….

Bank account number: ……………………………………………………………………..

SUBJECT OF COMPLAINTS:

Product purchase date: …………………………………………………………………………

Product name: ……………………………………………………………………………………..

Invoice number: …………………………………………………………………………………..

The total value of the product: ………………………… PLN/EURO

DECLARATION OF COMPLAINTS (description of defects and circumstances of their creation):
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When the defects were found ……………………………………………………………………………………………………

REPAIR ACTIONS / REQUESTING CLAIM:
(___) exchange of things for free from defects,
(___) removing the defect,
(___) price reduction,
(___) withdrawal from the contract.

………………………………………………… ..
Signature

SELLER NOTICE – DECISION CONCERNING COMPLAINTS
The complaint has been recognized / not recognized for the following reasons:
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Date of receipt of the complaint ……………………………….
The person considering the complaint ……………………………….
Date of consideration of the complaint ……………………………….
Further complaint proceedings – information for the client
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